Beauty Parlor Stroke Syndrome

March 25, 2017
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Story at-a-glance

Vertebral artery dissection from hyperextension of the neck, otherwise known as beauty parlor stroke syndrome, can occur after having your hair washed in a salon

When your neck is hyperextended over the edge of a shampoo bowl, the pressure and/or whiplash-like motions on your neck can lead to a tear in the vertebral artery, which supplies blood to your brain

Many other common activities, including sneezing, coughing, vomiting, painting a ceiling and practicing yoga, can also cause this condition

By Dr. Mercola

In 2013, Elizabeth Williams, a California mother of two, did something you’ve probably done many times yourself: visited a hair salon for a cut and routine wash. Several days later, she began experiencing strange symptoms indicative of stroke, including weakness on her left side.

Doctors ultimately diagnosed her with a relatively rare condition called vertebral artery dissection from hyperextension of the neck,1 otherwise known as beauty parlor stroke syndrome.

The act of extending her neck over the shampoo bowl was deemed to be the culprit, although it’s unclear if the condition resulted solely from a kink in the neck or in combination with a certain head movement caused by the stylist.2

Smith, who subsequently filed a lawsuit against the salon, conducted an informal poll of her friends’ stylists and found 80 percent were familiar with the possibility that you could have a stroke while getting your hair washed.3

What Causes Beauty Parlor Stroke Syndrome?

When your neck is hyperextended over the edge of a shampoo bowl, the pressure and/or whiplash-like motions on your neck can lead to a tear in the vertebral artery, which supplies blood to your brain. Dr. Steven R. Zeiler, head of stroke research at Johns Hopkins, told BuzzFeed:4

“When one of those cervical arteries is damaged in some sort of way, you can get what’s called a dissection, which is damage of the inside of the blood vessel, leading to abnormal flow and clotting, and then those clots can shoot north into the brain and cause a stroke.”

Having your hair washed is not the only act that can cause this — far from it — although it’s very rare, even when all potential causes are considered.

In a conversation with The Atlantic, Dr. Richard Bernstein, medical director of the Comprehensive Stroke Center at Northwestern Memorial Hospital in Chicago, explained that the phenomenon can occur due to innocent stretching, sneezing or even getting out of bed wrong in the morning, noting, “It is so rare that it’s a waste of time to worry about it. It’s so unlikely, and there’s really nothing you can do to prevent it.”5

Other Confirmed Cases of Beauty Parlor Stroke Syndrome

Beauty parlor stroke syndrome is not unheard of in the medical literature, and some studies even dispute the phenomenon’s supposed rarity.

In the International Journal of Stroke, for instance, a 2016 study found that hairdresser-related ischemic cerebrovascular events (HICE) “occur frequently in females without a predilection for the posterior circulation.”6

The researchers noted that while some cases may occur by chance, in other cases hairdresser visits may have a causal role.

A 2006 case study also relates the case of a 63-year-old woman who developed sudden dizziness, nausea and vomiting while having her hair shampooed at a beauty parlor. She was diagnosed with beauty parlor stroke syndrome with the researchers noting:

“Taken together, hyperextension combined with hanging the head backwards in a hair washbasin can be seen as a risk factor for posterior circulation ischemia. It probably occurs more often than assumed ...”7

Case in point: In December 2016 a U.K. man was awarded a more than $100,000 settlement from a hair salon after suffering a stroke two days after having his hair washed. The Daily Mail also reported another British woman who suffered a stroke in 2000 after having her hair washed at a salon.8

Cervical Support Reduced Dizziness and Other Symptoms During Hair Washing

Another study, this one published in 2002, examined symptoms of beauty parlor stroke syndrome among 25 volunteers who had previously reported dizziness during salon shampoos.

Among this population, significant dizziness, neck pain and carotid blood flow were reported while extending their necks over a salon sink, but the symptoms were significantly reduced when additional cervical support was used.

“Individuals with a history of such symptoms should probably exercise caution when deciding whether to receive a salon sink shampoo,” the researchers concluded.9

Yet another study in 2000 linked the hyperextended neck position during salon shampoos to cerebellum vascular insufficiency and recommended that “public education should lead to avoidance of this position during hair shampoo treatment at hair dressing salons.”10

While the risk of being injured during a salon shampoo is generally minimal, if you have experienced dizziness or other symptoms while having your hair washed previously, you may want to forgo the risk and wash your hair at home instead.

At the very least, some have suggested that adding a thick layer of towels to support your neck and reduce hyperextension may help.

Are There Risks to Getting Your Nails Done?

Hair washing is not the only potential risk at the beauty salon, particularly if you plan on getting your nails done. Nail salon services are big business in the U.S., amounting to $8.54 billion in spending in 2014.11

The fumes released by nail care products (and other beauty care products) is one concern, particularly for salon workers; however, the nail treatments themselves can also cause damage or infection to your nails.

Writing in The Journal of Clinical and Aesthetic Dermatology, researchers identified nail disorders that are induced by nail cosmetics via procedures meant to beautify the nail.12 On the contrary, many may lead to poor nail appearance and other risks.

Inadequately sterilized instruments, such as clippers, blades, abrasive files, electric drills and footbaths, may harbor and abet the growth of micro-organisms.

Micro and macro-traumas may be induced through the cleaning, filing and trimming of cuticles, thus allowing the infiltration of micro-organisms.

Materials, such as nail polish and nail enhancers, contain certain chemicals that can serve as contact sensitizers when accidentally applied to periungual skin [skin around the nail].

Chemicals, including acrylates, formaldehyde and toluene sulphonamide-formaldehyde resin, may lead to contact dermatitis and chronic paronychia [an inflammatory disorder of the nail folds]. Primers and polish removers, which are largely solvents, can dry nails and contribute to brittleness.”13

Less common disorders that can be caused by a trip to the nail salon include:14

• Mycobacterial infection, which can particularly occur from pedicure footbaths using equipment that is not properly sterilized or maintained with regular filter changes.

• Peripheral neuropathy, a type of nerve damage that is a rare complication of acrylic nails, possibly due to methacrylates that are sometimes used in artificial nail products.

• Worn down or overfilled nails, which is due to the mechanical trauma that occurs when acrylic nails are removed.

• Traumatic onycholysis, the separation of the nail plate from the bed, is very common in people with acrylic nails.

It’s caused by inserting thin sharp objects in order to clean under the nails. According to the study, “These patients usually wear very long nails, and adhesion of the acrylic nail to the nail plate is stronger than adhesion of the nail plate to the nail bed.”

What Else Can Cause Vertebral Artery Dissection From Hyperextension of the Neck?

As mentioned, having your hair washed is only one precipitating factor. Dr. Wouter I. Schievink of the Cedars-Sinai Neurological Institute in Los Angeles suggested that every year 1 to 1.5 per 100,000 people may suffer from spontaneous vertebral artery dissection from hyperextension of the neck and may account for up to one-quarter of nonhemorrhagic strokes in young and middle-aged adults.15

Aside from having your hair washed in a beauty salon, other possible causes include chiropractic spinal manipulation, lifting heavy objects or even drinking a shot of alcohol (which is known as “bottoms-up dissection,” according to The New York Times).16

In the case of chiropractic manipulation, it’s thought that up to one-fourth of people who suffer an arterial dissection may have an underlying disorder or defect that predisposes them to the dissection, and related pain may be what prompts them to seek chiropractic care in the first place. The Times continued:17

“A champion swimmer developed a dissected carotid from doing too much backstroke. Dr. Schievink also lists precipitating events associated with hyperextension of the neck, including '’practicing yoga, painting a ceiling, coughing, vomiting and sneezing,' as well as medical procedures like receiving anesthesia or being resuscitated and traumatic causes like motor vehicle accidents or sports injuries.

… There may also be an infectious factor in some cases, since the occurrence of carotid and vertebral artery dissections with no apparent cause peaks in the fall, when respiratory infections are most common.”

Writing in the Journal of Korean Neurosurgical Society, it’s suggested that many events associated with hyperextension or rotation of the neck may result in artery dissection. “Such neck movements, particularly when they are sudden, may injure the artery as a result of mechanical stretching,” the researchers noted.18 The symptoms of arterial dissection depend on which artery is affected and may include the following:19

✓ Pain on one side of your head, face or neck

✓ Paralysis of one eye

✓ Constant headache on one side of your head

✓ Pain behind an eye

✓ Impaired ability to taste

✓ Tinnitus

✓ Visual loss

✓ Temporary loss of awareness

Should You Avoid Having Your Hair Washed at the Salon?

There are many potential causes of arterial dissections, so you shouldn’t single out having your hair washed at a salon as a particularly serious risk. That being said, if you experience any discomfort or dizziness when in a position that requires over-extending your neck or looking upward for an extended period of time, you should take it seriously, change the position and seek medical attention if symptoms persist.

If you are concerned, talk to your hair dresser and ask for extra neck support during washing. Ideally, the chair and neck support should be adjustable so you can avoid hyperextending your neck. You can also forgo the process entirely and wash your hair at home. Ultimately, the risk of suffering from beauty parlor stroke syndrome is rare, but it does happen.